A prospective study of hepatitis C viremia in renal allograft recipients

In an attempt to study the im pact of HCV viremia on renal transplant clini cal course and outcome, we prospectively followed 133 HBsAg-negative end st age renal disease (ESRD) patients, in whom HCV-RNA-PCR results were availab le, from the pre- to post-transplant period. Eighty (60%) ESRD patients tes ted PCR-positive, of these, 12 (15%) were anti-HCV negative by second gener ation ELISA. The viremic patients had a longer time on dialysis (p < 0.001) , received more blood units (p < 0.001) and had a higher frequency of pre-t ransplantation liver disease (p < 0.001). Further, 41% of PCR-positive pati ents gave a history of antischistosomal treatment compared with 23% of PCR- negative ones (p = 0.048). Recipients with and without HCV viremia were fol lowed for a mean of 31.8 +/- 5.8 (range 6-42) months and 29.8 +/- 9 (range 6-41) months respectively, p = 0.14. While the prevalence of HCV viremia in creased from 60 to 64% at the last follow-up, the anti-HCV seroprevalence d ecreased from 63 to 61%. PCR-positive patients had higher rates of both acu te (p = 0.005) and chronic (p < 0.001) liver disease after transplantation compared with FOR-negative patients. However, none of our HCV RNA positive recipients developed a fulminant liver disease or hepatic failure until the last follow-up. Stepwise logistic regression analysis identified pre-trans plant liver disease (Odds ratio = 2.4; p = 0.07) and a cumulative corticost eroid dose in excess of 15 g at the last follow-up (Odds ratio = 3; p = 0.0 3) as independent predictors of post-transplant hepatic dysfunction in FOR- positive patients. Azathioprine was discontinued due to hepatic dysfunction in a significantly (p = 0.005) higher proportion of viremic patients compa red with the non-viremic ones. There were no significant differences betwee n FOR-positive and -negative patients in terms of frequencies and individua l causes of graft and patient losses. Our results demonstrate that HCV infe ction is extremely prevalent in Egyptian hemodialysis patients and is respo nsible for most hepatic dysfunctions after transplantation. Although HCV vi remia did not negatively affect graft or patient outcome until 31 months po st-transplantation, the authors would recommend that a viremic patient shou ld have a liver biopsy before transplantation and be immunosuppressed with caution post-transplantation. A longer follow-up may be required to exclude increased rates of HCV-induced hepatic mortalities. Copyright (C) 1999 S. Karger AG, Basel.